The current theory is that Listening therapy improves auditory processing speed by stimulating improved mylenation of the auditory pathways. Listening therapy also improves the integration between the various senses and support a more harmonious balance between the sympathetic and parasympathetic nervous systems. Gerritsen (2009)

At first glance, it appears as if our ears, our eyes and inner ear (balance) work independently – and that they have their own discreet neurological pathways that co-ordinate, or manage, each individual function. This couldn’t be farther from the truth. Each of these three systems talks to and receives information from the other two systems at all times.

The elaborate communication system between these three major senses must be coordinated smoothly and efficiently for optimal functioning to occur. This communication is achieved through what is called an integrated system: auditory, visual and vestibular (balance).

Electrical Stimulation: Sound waves entering the outer ear are transformed into electrical impulses in the inner ear and sent to the brain; those impulses provide energy to the brain and influence our ability to focus and sustain attention. (Brain scans show, for example, that children with AD/HD lack ‘energy’ in key parts of the brain for attention and focus.)

Movement + filtered music: Movement, through the interaction of the vestibular system and cerebellum, maximizesthe consolidation and integration of gains achieved in auditory retraining.

Listening vs hearing
There is an important distinction between hearing and listening. Hearing describes the process of collecting sounds while Listening describes what you do with those sounds thatyour ears collect. The quality of your listening affects balance and coordination, spoken and written language, alertness, creativity, and the ability to focus. How well you listen also influences your social development, confidence and self-image.

At one end of the spectrum are thosedeepin the autistic spectrum, who can hear perfectly, but areunable to listen.  In contrast, we see clients who work very hard to interpret every nuance of sound captured by their very poor hearing – this is the difference between a good and a bad listener.

Listening is shaped very early
Listening is a process that begins before birth - from the fourth month after conception. Sound literally helps the brain and the nervous system of the foetus to grow. Our mother’s voice is the first voice we hear and is I believe the most significant sound we ever hear. The quality of our mother’s voice plays a critical and foundational role in our ability to listen and communicate. Consequently, clinic-based auditory retraining, where practicable, uses a recording of the mother’s voice along with Mozart and the Gregorian chant.

Our maternal language is hard-wired, as is any very early exposure to a second or third language. That is why The “Australian ear” is so different from a “Japanese, an “American” or a “European” ear. So we each develop a unique set of neural pathways for language. These pathways profoundly influence our ability to attend, understand and communicate. They also shape our capacity to learn to speak another language, particularly if that language uses frequencies that are not important in our mother tongue.

Can we change the functionality of the brain?
Yes, the ability of the brain to change is known as neuroplasticity (also called brain plasticity, or brain malleability). It is the brain’s ability to reorganize itself by forming new neural connections throughout life. For example, if one hemisphere of the brain is damaged, the intact hemisphere may take over some of its functions. The brain compensates for damage in effect by reorganizing and forming new connections between intact neurons. In order to reconnect, the neurons need to be stimulated through activity. The same is true for parts of the brain compensating for injury or disease.

The brain is the seat of our language and thinking, and much of our creativity and learning. We now know that the brain is continuously plastic and remains adaptable into old-age and that it is not hard-wired in childhood. Perhaps more that anyone, Norman Doidge has popularised the concept of continuous adaptability which is called neuroplasticity.1 The brain continuously learns by experience - by recognising and mapping the sensory inputs that represent the repeating events in our lives. This is how our brain works out what is important and what is not and allow us to predict what is likely to happen next. With each new experience, as we build knowledge and new skills, our brains are continuously remodelled, to respond more and more fluidly to the stream of events that make up our lives.

The cerebellum (lower back side of the brain, near the brain stem) can be likened to a powerful computer processor, transferring vast amounts of information to the movement, language, reasoning, sensory, and emotion parts of the brain; it’s role is so important that it contains more nerve cells than the rest of the brain combined.

Automaticity: The cerebellum, which lies immediately above the brain stem, has long been known to control the rhythm and timing of movement. The vestibular system and the cerebellum constantly interact to give expression to the rhythm and timing of complex movements. More recently, much research has been carried out on the cerebellum’s role in learning. It plays a large role in making things become automatic (an ability known as “automaticity”).

When properly integrating inputs from the vestibular, auditory and visual systems, as well as the executive centres in the frontal cortex, the cerebellum allows us to practice activities until they become automatic. When the cerebellum is not functioning properly, our ability to learn is inhibited. Learning to read, for example, becomes impossibly difficult and frustrating. Imagine having to start all over again every time you tried to learn the alphabet, or ride a bike, or spell…

So the role of the cerebellum is to coordinate sensory information inflows to the brain. It also provides linkages and a context to each sensory, emotional and cognitive input. The cerebellum allows us to multi-task – to sit still at a desk and copy from the board, to drive a car and talk with the kids in the back seat or to ride a bike and continue a conversation with a mate.

How can Integrated Listening therapy help?
iLs programs stimulate cerebellar activity to strengthen neural connections and, in the process, improve our ability to automate basic reading, writing, spelling and maths skills. Our programs also stimulate the brain to develop the connections in our brain which allow us to complete our daily tasks with less effort. It allows one to automate everyday tasks like getting ready for school (organising), playing football (hand-eye coordination, predicting, responsivity) or playing with mates in the playground (decoding verbal and non-verbal signals, socialising).

Listening therapy improves the clarity of sound messages reaching the brain by increasing blood flow to the auditory pathways. This increased blood flow also strengthens the auditory pathways .The circulatory system is one of the primary channels for the flow of vibrational energy through the body.2

So what are your ears for?
At first glance your ears are simply to allow you to hear. Certainly, the collection and processing sound without distortion is an important function. But your ears also allow you to discriminate pitch (higher vs lower frequencies). This allows you identify the key parts of a conversation and to discriminate a question from a statement. Ears allow you to identify where sounds come from. They also allow you to focus on those sounds you want to hear and tune out from those that are less important. Recent research (Sininger, 2004) has confirmed that the ears have slightly different functions; the right is optimised for speech and language while the left is optimised for music.

Your ears collect sounds, which provide important stimulation for the brain. They integrate sensory information from muscle movement. An example of this is when your eyes automatically move towards an unexpected sound. Your ears also allow you to establish and maintain good balance/equilibrium they allow you to control your voice and develop your musical ability.

Relay stations to the brain: The vestibular (semicircular canals) and cochlear systems, located in the inner ear, work together to relay sensory input to the brain. They play a key role in our ability to integrate our senses, and their successful interaction is essential for language development, sensory processing and motor function.

More specifically, once sound arrives at the brain stem from the cochlea, the special centre in the inner ear where sound is transduced to nerve impulses, it passes upwards towards the speech centre in the cortex via a number of relay stations or nuclei.

How can listening therapy help?

The specially treated music has been designed by iLs to influence the function of the ear drum and adjacent bone, as well as improve the processing that occurs at these relay stations. So, for instance, there is an improvement in the ability to perceive where sound is coming from, thereby making it possible to perform tasks requiring convergence of information from both ears (the cochlea nucleus).

Our programs are also designed to help normalise:

• Hearing sensitivity
• Blood flow to the auditory system.
• Right receptive dominance

What is the vestibular system and why is it so important?

The vestibule, located in the inner ear, has 3 main functions:

• Balance As the primary organ of equilibrium, it plays a major role in the subjective sensation of motion and spatial orientation
• Posture Vestibular input to areas of the nervous system elicit adjustments of muscle activity and body posture
• Eye Movement Vestibular input to the nervous system helps stabilise the eyes during head movements

A well-modulated vestibular system is important for controlling the nervous system's level of arousal. While many clients have never heard of their vestibular system, everyone relies on this ‘hidden’ sense every day because it allows you to:

• Maintain your balance, and movement particularly in the dark when you cannot use  visual cues
• Affects muscle tone
• Differentiate a ‘p’ from a ‘d’ or a ‘q’
• Maintain good posture at your desk and accurately copy from the board in a  classroom
• Sense when you are accelerating, braking or turning such as while driving or while playing a sport
• Sense where you are in space such as when you are hanging upside down, spinning or changing direction on playground equipment
• Sense your change in balance when an aircraft finishes climbing and has reached cruising attitude

Given these many important functions, you can appreciate how important the vestibular system is for learning and life performance.

Vestibular dysfunction
We see many clients with poorly performing vestibular systems. This can undermine their quality of life andconstraintheir ability to participate in a range of mainstream activities inside and outdoors.  Examples of this drawn from our case-files are:

• Loss of balance when you shut your eyes - a middle-aged client fell over in the shower if she shut her eyes briefly to wash her face
• Intermittent or chronic vertigo, dizziness and or nausea – this can make a normal lifestyle impossible to maintain..
• Significant motion sickness
• Difficulty maintaining balance (static or moving)  especially on uneven ground
• Avoidance of playground equipment like swings and spinners
• Reluctance to engage in activities that involve a lot of movement especially the head

How can Integrated Listening Therapy help?
iLs programs are designed to strengthen the vestibular system with the integration of auditory and balancing activities. The bone conduction Listening systems used in clinic (DLS/iLs) and at home (iLs Focus) have a much greater capacity to influence vestibular function.

Pitch discrimination (also called selectivity)
Further on, (in the colliculus), processing influences the ability to recognize the relationship between high and lower tones and the integration of sound with other sensory information (ie. vision). This ability to differentiate a higher from a lower tone is critical to distinguishing between a question and statement, and determining the tone of speech. Those with poor selectivity often can not hear the tone and therefore struggle to interpret the meaning.

So Pitch discrimination allows us to decode the emotional content of language and to identify if you are hearing a joke or sarcasm and to identify the most important part of an instruction.  Those with poor pitch discrimination are often tired by the extra effort needed to understand those speaking to them. Poor pitch discriminators can also experience a chronic uncertainty about what is really meant by those speaking to them which is a significant cause of anxiety in the children we see.

Pitch discrimination also help us distinguish between letters that sound alike, particularly when we are learning a language. Those who struggle with the difference between a “p” and “b”, or a “t” and “d” are at a disadvantage in reading, spelling and writing.

These receptive language weaknesses undermine the development of age-appropriate language and communication skills. Another aspect of this is that those with weak pitch discrimination often find it hard to think clearly and find it difficult to set out their thoughts on paper and may cause some symptoms of dyslexia.

Another significant deficit that we commonly observe in children with weak pitch discrimination is emotional immaturity.  These children are easily upset by seemingly quite small matters in their daily routine.

How can listening therapy help?
In almost all cases, our bone conduction listening therapy is able to deliver age-appropriate pitch discrimination. The more powerful clinic-based equipment is the preferred choice for those with more significant deficits. As Selectivity opens, we tend to see emotional maturation, more fluid verbal and written expression, less anxiety and more energy. Clients also report feeling happier about themselves as their self-esteem rises.

Listening is one of the fastest things our brain has to do. For example, it takes only 40 milliseconds to distinguish the word cat from cut. Consequently, many children struggling with language have difficulty tracking rapid acoustic changes. This undermines their ability to map the component language sounds which we associate with letters. Such children will struggle to retrieve these sounds as they are reading and will struggle to become a proficient reader.

Tallal, Warnke and others have established that processing speed for adequate speech comprehension needs to be faster than 100 milliseconds (ms). Children with a learning difficulty and/or an attention deficit are SLOW processors, while children with ADHD process normally or faster. If your processing is slower than 100ms, you will not be able to distinguish the ‘t’ from ‘i’ in ‘ticked’- you cannot sort out which sound came first, and spelling will be difficult.

If your processing is slower than 200ms, the "ck" sound will add more confusion. If it is slower than 400ms, you will be unable to make any sense of the word.1 We see children with processing times as slow as 1000ms. Depending on their intelligence, these children can have severe language delay and speech problems.

Processing speed can be thought of as the amount 'thinking' time needed before one can respond and it is correlated with attention. Slower processing makes it harder to capture information, process it and respond in a timely manner. Research by Tallal suggest that children with an attention deficit often processes sensory inputs far too slowly while hyperactive children have normal to very fast processing speeds. 

How can Integrated Listening Therapy help?
By stimulating the neural pathways to and from the brain, iLs programs can significantly improve the brain’s speed of processing - for both auditory and visual stimuli. My ongoing research tracking study has identified that, on average, after completing a clinic  iLs / DLS Listening program, client’s processing speed increases by 100% or better. This doubling in processing speed delivers a significant improvement in auditory comprehension in the classroom.

Sound + Movement
The inner ear is made up of not one but two organs – they are called the cochlea and the vestibule. These two organs allow us to collect vibration. The cochlea collects the vibrations of sound and the vestibule senses the vibration of your movement and your position in relation to gravity.

These two organs work together in a great team. In fact, they are inseparable - like twin brother and sister or yin and yang. These organs allow you to perceive and comprehend the changes, rhythms and sequences in these vibrations. Where there is life, there are vibrations ~ Vibration=Life. 

Ears + Eyes
Your ears collect the sounds which provide critically important stimulation for the development of the brain. Your ears and eyes are integrated and work together as a team. An example of this is when your eyes automatically move towards an unexpected sound. The vestibular system helps to coordinate your eye movements and aids the synchronicity of the eyes and ears.

We read with our eyes and our ears
Reading requires both your ears and eyes to co-operate seamlessly. As your eyes move from letter to letter, your brain translates each letter into a sound to assemble a familiar word and these words convey the meaning of the story. If your vestibular system does not allow you to accurately identify your rotational movement in space, it is unlikely to be able to differentiate ‘b’ from‘d’, or ‘p’ from ‘q’. The reason for this is that these four letters are all the same symbol, but rotated differently.

If your ears cannot distinguish the similar sounds that make up a t” and “d”, this will also make written language challenging. If you have a visual problem and cannot easily see the letters on the page or the board, then this will also cause you to struggle to read.

Some children cannot integrate their ears and eyes because they did not crawl as babies. This causes a ‘midline’ problem which generates a deficiency in the integration between the two hemispheres of the brain. This gap in their motor development makes it impossible for them to smoothly scan a line of text on a page. These clients struggle to read and write have written language skills which lag behind their peers. A midline issue can also undermine sporting performance because it also makes is difficult to tie shoelaces or smoothly coordinate ones arms or legs when they cross the midline of the body.

Cerebellum
The cerebellum at the back of the brain, plays a critical role to ensure the smooth integration of movement, thought and emotions. It facilitates teamwork between the eyes and ears which allows you to have fun outside with your mates – to ride a bike or to navigate the monkey bars. The cerebellum allows you to breathe, laugh and talk while you are  walking. It helps you to automate everyday tasks and to manage complex sensory information flows without overloading. We see many clients with poorly a performing cerebellum. This can undermine your quality of life and constrain your ability to participate in a range of mainstream activities.  Examples drawn from our case-files include:

• One young client could not maintain his grip on the monkey bars and talk. If you said “hello”, he fell to the ground!
• Some clients are clumsy and they trip over objects on the ground, particularly if they are chatting to mates.
• Many children dislike and avoid team sports because they cannot manage their balance or run competently.

Why is Integrated Listening therapy so helpful?
By now, you may have realised that the auditory, vestibular and visual systems work together to build our ability tolearn, pay attention, process information, and move our bodies smoothly.

Our integrated programs work so effectively because they combine movement, listening, & visual stimulation. By “exercising” these three systems simultaneously they strengthen the teamwork between these three systems. So this holistic approach gently builds the capacity of the brain to more rapidly make sense of the multi-sensory information flows that are a feature of today’s classrooms. These classrooms overwhelm many of the children that we asses in our clinic.

Our sensory programs are designed to improve the capacity of your brain by building and strengthening the neural connections which you need to fulfil your daily tasks. This allows you to learn easier and improve your life performance. Our sensory programs are designed to build your sensory integration.

Why Mozart?
Mozart is the favoured music for auditory retraining. Tomatis describes Mozart’s music as “a celestial message”, “The unique phrasing of Mozart is innocent and light, rich and warm. … (it) transports and immerses us in a different state … He knew how to lead humanity to a place where only beauty, transcendence and joy of living existed.  ... Mozart is the freshest, the most serene and the youngest of composers.”

In Mozart there is an indefinable something that differentiates him from the other composers. His phrasing, rhythms and sequences have integrity and a liberty that allow us to breathe and think easily (from Why Mozart?).

Tomatis describes how Mozart’s music enhances us neurologically: “This (music) creates a basis, a foundation, on which language is structured. … an infrastructure for the body, and the nervous system, thanks to the energy that it brings to the brain. … Mozart awakens the potential of his listener”. Rauscher (93, 95) claims that listening to Mozart raises IQ (spatial reasoning).

Musical variety
The music of Mozart has an unparalleled capacity to facilitate neural change because of the unique structure phrasing in his compositions. While Mozart is special, we also use appropriate Baroque and medieval compositions to deliver a diversity of auditory stimulation.

For example, Symphonies incorporate a high degree of complexity and deliver significant dynamic range. The Cello is exceptionally rich in low frequencies. The Waltz delivers strong rhythm and is fun for r children. While the male and female Chants deliver magnificently resonant harmonies.

The violin concerti deliver unsurpassed high frequency overtones. Each of these musical patterns has a special place and a specific use in the rebuilding of the auditory perception of our clients.

We also use a recording of the mother’s voice because this is the most profound communication we receive during that important period before birth when very significant parts of sensory processing networks are created. We also use a microphone to allow the client to build an awareness of and skill using their own voice.

We have tried and discarded many other musical styles and genres because they cannot match the therapeutic efficacy of the Baroque period.

Psychoacoustics
We subtly modify the original music to allow us to deliver stimulation to the nervous system that is both powerful and gentle. We use filtration to emphasise or de-emphasise the various frequencies. This allows us to train the auditory system to more appropriately attend to and recognise the full range of frequencies so that we can better comprehend verbal communication from teachers, parents, friends, supervisors or colleagues. We use balance to build spatial awareness skills.

One of the most powerful technical elements of the processing is the gating which is designed to train the auditory system to effectively attend to meaningful sounds while down-regulating less meaningful sounds like background noises. Perhaps the most powerful element of iLs Listening therapy is bone conduction. This is designed to re-train the vestibular system as well as the internal-emotional aspects auditory processing. It is a powerful tool to help those who are anxious, over-emotional or immature. 

In our clinic programs, we can structure each program by customising the music to meet the individual needs of the client for each session.  We carefully select each piece of music; determine its filtration, the extent of the gating, air and bone conduction volume as well as balance.

The earlier sessions in a program make up the receptive phase because they involve a client quietly listening to the musical program. All clinic programs gradually build in intensity until the final stage where we integrate the client’s own voice with filtered music. This final stage is called the expressive phase because the client is learning to use their own voice to communicate more confidently and effectively.

For ease of use, the home programs have been simplified so that clients select an appropriate volume and balance while they listen to a pre-recorded program.

In all programs, we can adapt the speed at which we proceed according to the needs of each client. We can also adjust a program according to the adaptability of a client’s auditory perception as monitored by either the clinician or their guardian at home. We can integrate an expressive phase in any home program with the addition of a microphone and a mixer box to allow you to learn how to use your voice.

Alfred Tomatis

The Origin: French ear nose and throat specialist Dr Alfred Tomatis (1919-2001) pioneered the field of auditory retraining in the late 1940s. Tomatis was the son of an opera singer. He starting his practice by treating opera singers who had so deafened themselves with their own voices that they were unable to perform. He also treated munitions workers with industrial deafness who were seeking workers compensation. The workers had lower than normal voices, their speech was poorly articulated and the singers sang off-key.

As Dr. Tomatis used these techniques on the musicians’ children, he observed improvements in their academic performance (including improved memory, focus and attention span) as well as in their posture, co-ordination and balance.

To his surprise, Tomatis found these two disparate client groups had much in common. They all had a significant dip in their listening at the same pitch (4kHz). By experimenting to restore the “lost” frequencies, he discovered the link between listening and the voice and was then able to repair both their listening and their voices. His remedial work became increasingly successful with both the singers and factory workers.

The friends of Tomatis senior brought their children to Dr Tomatis for a listening tune-up to improve their singing. The magic happened twelve months later when almost all these parents reported that their children’s school performance had unexpectedly improved. Tomatis had stumbled across the connection between listening and learning. Use this discovery; we help many with listening programs (sound therapy).  While these programs are relatively new in some counties, they have been successfully used for many decades in France.

Plasticity: At a time when the idea of plasticity of the brain was in its infancy, Dr. Tomatis discovered that it was possible to retrain and improve the processing of sound by the brain stem and cortex using filtered music (i.e. music with certain frequency ranges removed or enhanced) and the sudden and random alteration to the pitch or tone of the music (‘gating’).

The Tomatis effect
In an effort to understand the link between the ear and the voice, Tomatis discovered the following laws:

The voice can only reproduce what the ear hears or as Tomatis put it: “one sings or speaks with one’s ears” (this is known as the Tomatis Effect).

If one correctly retrains a damaged ear to hear any lost frequencies, these are instantly and unconsciously restored to the voice.

Sufficient auditory stimulation will provide a lasting improvement in the ability to listen and reproduce sound.

His ideas were so revolutionary that they threatened the French medical establishment and he eventually abandoned surgery to concentrate on his listening practice. By 1957 the French Academies of Medicine and Sciences acknowledged his achievements by naming his first law the Tomatis effect. So if there is a pitch that you cannot reproduce when singing or a sound that you cannot reproduce when talking, it is probably because you cannot clearly hear those sounds.

Tomatis went further and discovered that if the perception of any part of the audible range is significantly depressed then this will diminish your sense of well being, your ability to communicate or to learn. This explains many of the learning difficulties in children with early ear infections.

Tomatis discovered that the ear is like a battery with a primary function of converting sound to electrical waves that charge the cortex of the brain – particularly high frequencies. So sound is a nutrient; you can either charge or discharge the nervous system by the sounds you take in through your ears and through vibrations on your skull.

Listening programs
Tomatis designed a machine called the Electronic Ear to provide individual listening programs using mostly the music of Mozart, with Gregorian chants and recordings of the mother’s voice. These machines and their successors like the Dynamic and Integrated Listening Systems are now in use in clinics around the world. Tomatis’ discoveries have spawned a variety of listening therapies designed for use at home using headphones and portable music players.

Listening and the "ideal" ear
Tomatis developed the listening test to measure how well a client perceived sound. Over many decades of clinical observation, Tomatis derived the ideal listening curve.  We routinely use the Listening Test to assess clients and it forms the basis of many of the interventions to improve learning and help clients to reach their potential.

The listening test measures the quietest volume or loudness for each tone that a client is aware of. The test separately measures these perceptual thresholds for each ear and for sounds vibrated directly onto the skull. The essential features of the ideal curve are:

• Ability to hear reasonably quiet sounds (ie normal listening thresholds);
  
• A similar and balanced response on both sides;
  
• A smooth curve peaking at 3-4kHz to allow easier discrimination between sounds;
  
• An ability to discriminate higher and lower pitches;
  
• Ability to accurately identify the direction of the sounds, and
  
• Adequate perception of high frequency sounds to stimulate the brain.